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Evaluating CAPDOTS Training for Children and Adolescents with APD by Jay R

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Evaluating CAPDOTS Training for Children and Adolescents with APD by Jay R ONLINE EXCLUSIVE Evaluating CAPDOTS Training for Children and Adolescents with APD By Jay R. Lucker, EdD, CCC-A/SLP, FAAA; Cydney Fox, AuD; and Bea Braun, AuD uditory processing disorders (APD) in school-age children can lead to learning problems.1 Audiolo- gists may determine the presence or absence of APD in this population and make specific thera- Apeutic recommendations. However, many therapies for APD have not been peer-reviewed or examined with statistical analysis to determine efficacy. The present study evaluates a therapeutic option called CAPDOTS-Integrated (also referred to as CAPDOTS), an online training program that aims to im- prove dichotic listening problems. According to Jerger, “Dichotic listening (DL) tests are at the core of the diagnostic evaluation of auditory processing disorder... [Such tests] have been used for decades both as 2 screening tools and as diagnostic tests in APD evaluation.” Thus, audiologists evaluating school-aged children for APD AdobeStock may find these children to have dichotic listening problems. Those diagnosed with dichotic listening problems are rec- subjects.2 The 27-year-old subject identified as diagnosed ommended to try a dichotic listening training program, such with “binaural integration deficit” only completed 80 percent as CAPDOTS-Integrated.1 Presently, CAPDOTS-Integrated of the CAPDOTS training. The 16-year-old subject is re- claims to treat binaural auditory integration problems known ported diagnosed with a binaural integration (dichotic listen- as dichotic listening difficulties. CAPDOTS is a treatment ing) auditory processing disorder. Results of mid-latency program requiring access to the internet and good quality electrophysiological measures revealed increased response headphones. It can be completed in the trainer’s office, at findings after these subjects completed CAPDOTS. Quali- school, or home.1 On their website, it states that CAPDOTS– tative data discusses the Na-Pa amplitude changes and per- Integrated “improves the ability to follow complex, multi- cent differences for each subject. Statistical analyses were step directions, listening attention especially in distracting not used so there is no indication whether these changes background noise, inferential listening and understanding of were significant. group instructions, auditory memory, academic perfor- The second conference presentation, also by Carol Lau, mance especially for reading comprehension and spelling.”1 used only three subjects, all identified as having auditory pro- However, one may ask what evidence supports these cessing problems based on scores from the SCAN and claims? Dichotic Digits Tests.4 Number values are the only results pro- vided. There were no statistical analyses discussed. A third reference is an article published in The Hearing EVALUATING THE SUPPORTING Journal on a study involving three adults identified with co- RESEARCH morbid peripheral hearing loss and CAPD.5 Each subject was The CAPDOTS website cites two conference handouts on used as a single case study presenting results of auditory pro- the changes after CAPDOTS training. Carol A. Lau dis- cessing tests pre- and post- CAPDOTS training. Findings cussed mid-latency, electrophysiological responses in two identified improvements after CAPDOTS training, but no sta- tistical analyses were provided. From left: Jay R. Lucker, EDD, CCC-A/ Another study published in 2013 used individual case SLP, FAAA, is a professor and the presentations including one of a second-grade boy with audi- director of the five-year accelerated tory processing problems, an older adult who suffered a head master’s degree program in the de- injury, a preteen with no history of educational or auditory pro- partment of communication sci- ences and disorders at Howard cessing concerns, two girls identified by qualitative observa- University in Washington, DC. He tions having problems following verbal interactions and also has a part-time private practice specializing in issues related to audi- directions, and an adult with a history of learning disabilities.6 tory processing disorders. Cydney Fox, AUD, is a member of the Craniofa- All subjects were evaluated using the SCAN test as well as cial Team at Orthopaedic Hospital and a full-time audiologist at Audiology Dichotic Digits. Data compared pre- and post- CAPDOTS Solutions LA. Bea Braun, AUD, is a clinical audiologist and a credentialed educational audiologist. She founded the Auditory Processing Center of training with improvements noted, but no statistical analyses Pasadena. were provided. The Hearing Journal April 2021 ONLINE EXCLUSIVE Table 1. Ranges, Means, and Standard Deviations Table 1. Continued... for each of the Measures of Auditory Processing Standard used in the Present Study (N = 46) Test Measure Range Mean Deviation Standard Test Measure Range Mean Deviation Left Ear First RE-pre 4-15 10.3 2.88 Competing Right ear-pre 80-100% 93.9% 6.58% RE-post 8-15 12.3 1.62 Sentences LE-pre 3-13 8.2 2.57 Right ear-post 88-100% 97.4% 4.44% LE-post 5-14 10.1 2.23 Left ear-pre 50-100% 78.6% 15.97% SCAN-3 Left ear-post 30-100% 80.4% 19.17% Auditory Figure- Dichotic Right ear-pre 50-95% 84.7% 13.61% Ground +8 RE-pre 17-20 18.6 1.1 Digits RE-post 16-20 18.7 1.4 Right ear-post 73-100% 92.9% 7.33% LE-pre 13-20 18.1 1.9 Left ear-pre 35-95% 74.0% 14.20% LE-post 16-20 18.8 1.1 Left ear-post 40-100% 82.4% 50.58% Duration Pre 40-73% 50.6% 18.44% SCAN-3 Patterns Time RE-pre 17-30 25.7 3.7 Post 17-84% 56.0% 20.09% Compressed Frequency Pre 10-100% 58.5% 24.59% Sentences RE-post 22-30 27.8 2.9 Patterns LE-pre 19-29 24.9 2.7 Post 50-100% 84.7% 16.27% LE-post 22-30 26.9 2.2 Low Pass Right ear-pre 32-90% 71.6% 17.36% Filtered Right ear-post 64-92% 82.9% 8.90% Left ear-pre 32-86% 66.4% 16.32% PURPOSE OF THE PRESENT STUDY Left ear-post 40-96% 79.4% 14.03% Studies have looked at changes in auditory processing after Phonemic Quantitative- 0-23 16.2 5.51 completing CAPDOTS training. However, none provides sta- Synthesis pre tistical analyses, and all use small samples. The present Quantitative- 16-24 20.6 2.98 looked at a large sample of children and adolescents diag- post nosed with APD. The researchers measured what changes Qualitative-pre 2-23 13.9 5.73 occur when statistical analyses are used. The research ques- Qualitative- 8-24 18.8 4.51 tions asked whether auditory processing test findings re- post vealed significant improvements after completing CAPDOTS SSW RNC-pre 0-10 2.6 2.61 training, and for what specific measures, as well as investigat- RNC-post 0-4 0.6 0.99 ing the degree of improvement following training. RC-pre 0-27 8.6 5.95 RC-post 0-15 3.1 3.42 STUDY METHODS LC-pre 5-34 14.3 6.93 Forty-six children and adolescents (26 males and 20 females) LC-post 2-22 8.3 5.09 participated in the study. Two of the authors (CF and BB), LNC-pre 0-19 3.9 4.18 both licensed clinical audiologists, evaluated participants LNC-post 0-7 1.2 1.39 identifying all having significant APD. Participants ranged SCAN-3 from 6 years to 18 years with a mean age of 10.0 years Competing RE-pre 6-35 12.3 8.67 (standard deviation of 2.70 years). Participants had normal Sentences hearing which would not influence their auditory processing RE-post 12-35 12.6 7.19 or treatment. LE-pre 4-34 8.2 8.14 Auditory Processing Tests: Auditory processing was as- 7 8 LE-post 10-22 9.2 6.03 sessed via the SCAN-3 C for children and A for adolescents 9 SCAN-3 Dichotic Digits (DDT), Frequency Patterns and Duration Pat- terns,10 Competing Sentences,11 Low Pass Filtered Speech,12 Competing Words- Directed Ear SSW Test,13 and the Phonemic Synthesis Test (PST),14 using Right Ear RE-pre 3-14 10.7 2.49 First the specific scores for each ear or individual measure on the tests. RE-post 7-14 11.5 2.03 CAPDOTS Training: CAPDOTS is a web-based therapy LE-pre 1-12 6.8 2.86 based on a Staggered Dichotic Listening Training (SDLT) LE-post 5-14 8.8 2.52 paradigm, using words, digits, and syllables. SDLT uses a difference in the timing presentation of targets in each ear April 2021 The Hearing Journal ONLINE EXCLUSIVE RESULTS & DISCUSSION Table 2. Results of Paired (Dependent) Samples A total of 24 measures were completed in the study. Table 1 t-tests on all Measures presents the results of the pre- and post- CAPDOTS meas- Test Measure t p ures, indicating large differences between the post- and pre- Competing Sentences Right ear 1.550056 0.1494 therapy findings. Table 2 shows the t-test statistical analyses results, which Left ear 0.547209 0.59516 reveal significant findings for 16 of the 24 measures. Only Dichotic Digits Right ear 5.887257 <0.00001* one dichotic measure (Right Ear for Competing Words- Left ear 2.531742 0.01743* Directed Ear Right Ear First) was not significant. The remain- Duration Patterns 1.234108 0.24288 ing 7 dichotic measures were significant. Thus, significant Frequency Patterns 5.803375 <0.00001* findings were found for 7 of the 8 dichotic measures of audi- tory processing. Low Pass Filtered Right ear 2.61608 0.02134* Surprisingly, CAPDOTS training not only significantly im- Left ear 3.585902 0.00332* proved dichotic listening but also made significant improve- Phonemic Synthesis Quantitative 5.809389 <0.00001* ments in other areas of auditory processing.
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